Airway management in the pediatric emergency department in Japan: A multicenter prospective observational study. Issue 1 (30th September 2022)

• Record Type: Journal Article
• Authors: Hagiwara, Yusuke; Goto, Tadahiro; Ohnishi, Shima; Miyamoto, Daisuke; Ikeyama, Yuki; Matsunami, Kunihiro; Hasegawa, Kohei
• Is Part Of: Acute medicine & surgery. Volume 9:Issue 1(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-09-30
• Subjects: Airway management -- children -- congenital anomaly -- first attempt success -- intubation; Surgery -- Periodicals; Medical emergencies -- Periodicals; 617.005
• DOI: 10.1002/ams2.798
• Languages: English
• ISSNs: 2052-8817

Abstract

Abstract : Aim: Tracheal intubation is a vital resuscitation procedure in the pediatric emergency department (ED). Despite its importance, little is known about the current status of emergency airway management in Japan. In this context, we aimed to investigate the airway management characteristics—particularly the location, patient, and provider factors—in the pediatric ED. Methods: We conducted a multicenter, prospective study of five pediatric EDs in Japan from October 2018 to June 2020. The study included all children (aged ≤18 years) who underwent intubation at the pre‐ED or ED setting by physicians and those who were transferred from the ED to the operation room (OR) or pediatric intensive care unit (PICU) for intubation. We described the airway management characteristics according to the location, patient, and provider factors. Results: Of 231 children, 9 (4%) were transferred to the OR or PICU for airway management. Among the remaining 222 children, 45 were intubated at the pre‐ED setting and 177 were intubated in the ED. The overall first‐attempt success rate was 72%, with the rate varying by location, patient, and provider factors—for example, 68% at the pre‐ED setting, 67% for children <2 years, 56% for children with airway‐related anatomical anomalies, and 61% with intubation by a resident physician. Intubation‐related adverse events were observed in 17%, most of which were hypoxemia (14%). Conclusions: Based on data from a multicenter prospective study, the overall first‐attempt intubation success rate in pediatric EDs in Japan was 72%, with large variations by location, patient, and provider factors. Abstract : In this multicenter prospective observational study of 231 emergency department (ED) children in Japan, we found that the overall first‐attempt success rate was 72%. However, the rate varied across location, patients, and provider factors (e.g., 68% at the pre‐ED setting, 67% for children <2 years, 56% for children with airway‐related anatomical anomalies, and 61% with intubation by a resident physician). Implementing high‐quality airway management for patients with these factors is required in the pediatric emergency department.